All By Myself...

Whoa. Silence.

Mr. Couz has loaded up big dog and velcro dog and headed out to the boonies to spend a few days with his family. Dr. Couz, of course, is stuck working. But now I have four whole days with an empty house and I'm at a bit of a loss as to what to do with it.

But I'd like to state proudly for the record that within 20 minutes of my husband leaving the house, I had managed to blow a fuse in the kitchen for having the audacity to run the kettle and the toaster at the same time. Ah, the glory of living in a 100-year-old house. That's not what I'm proud of, though. I ventured down into the dungeon-like basement, located the fuse box, and solved the problem. Considering that it was something I had never done before and that I am usually irrationally afraid of our basement (don't ask), this was a pretty proud moment. Hey, I appreciate the small victories.

So now I'm headed to the gym to do my long run for the week-- 10k (or a little over 6 miles for you Americans out there). It will be mind-numbingly boring to do it on the treadmill, but there is a lot of very slippery snow on the sidewalks and it would be a really bad time for me to be on crutches. Plus, it's not the same without a furry companion.

Then, the plan is to shower at the gym and head out to pick up a few groceries for the week. Due to my schedule this job is usually done by Mr. Couz, so I'm actually kind of excited about doing it today. There hasn't been enough money lately for fun shopping, so I'll take whatever kind of shopping I can get to get my fix.

Post-groceries I'm headed out to Starbucks to continue my studying (okay-- start my studying) for my CCFP exams. They're fast approaching. And I'm not doing much of anything about it.

My day might be shot to hell, though, as it seems that my LAST prenatal patient (the last patient we have scheduled to deliver while I'm still on service in family medicine) has ruptured her membranes. She's term (39 weeks), GBS negative, and the baby looked fine on the fetal monitor so there's really no cause for concern, but for some reason they admitted her last night anyway. So now I'm waiting to find out my preceptor is going to induce her or what. And if he does, I'll probably have to make the hour trek out to the community where I practice to deliver her. She's a primip, so she might not be pushing until tomorrow morning. I don't understand why they don't just wait at least 24 hours and see if she goes on her own. But either way, I'll be tethered to my cell phone waiting to hear if I'm expected to drive two hours just to catch a baby. I'm not quite as enthusiastic about the deliveries as I was before as I've recently learned that I've exceeded my obstetrical requirements for family medicine threefold easily, and have decided not to include uncomplicated obstetrics as part of my practice in the future. A pretty easy decision to make now that I have a spot waiting for me in the emergency medicine fellowship.

Lots of blogging on the burner, though. I have posts in progress on the subject of the us vs. them mentality that so many practitioners of alternative medicine seem to possess, the answer to a commenter who wondered if I'd come to terms with my childbirth preference or if I was still torn between the extremes of elective c-section and midwife-assisted birth, and some thoughts on the anti-vaccination movement. Now that I've committed to these topics, I hope I'll feel forced to see them through to completion.

And don't forget that Grand Rounds version 3.20 will be hosted by yours truly on February 6th. I can't wait to start reading the submissions. If you have a recent blog entry that you feel might interest readers, send it in. I'm not going to be terribly strict in enforcing the theme this week. The deadline for submission with be 10pm EST on Sunday, February 4th.

On the Road Again

At about this time last year, I took up running. Some of you who have been reading my blog since the start might remember the trials and tribulations of my plantar faciitis at that time. The funny thing is, I hate running. I always have. But at some point in my athletic career, running became the holy grail of athleticism. If you could run, you were fit. If you could run, you were an athlete. It didn't matter how good I was at jiu-jitsu, kickboxing, rowing, softball or any of the other more competitive pursuits I've been involved with in my life, I always looked at runners with envy.

It wasn't that I hadn't tried to run. I had completed the Couch to 5K program no less than three times. After my second year of medical school I completed the Learn To Run program through The Running Room with two of my friends. At the end of the 10 week program I could get through 5k, but still hated every painful minute of it. Regardless of how long I spent on the elliptical trainer at the gym or how much I was able to squat I never got any good at running. I just figured that my body wasn't built for it.

Last spring I decided to give running yet another kick at the can. I wasn't finding the time to make it to the gym regularly, and running had the added bonus of walking the dog at the same time. I'm all about the multitasking.

So I started slow. Big dog loved it. He got so used to our 5:45am wake up times that if I dared hit the snooze button he'd plop his big head up on the bed so that his nose was nearly touching mine. He was not a training partner that would take no for an answer. So I'd get up and run. And walk. And run. And walk some more. And pretty soon, I was doing more running than walking. And pretty soon after that, I was running 30 minutes straight. I still didn't love it, though.

There were obstacles. A heat wave in the summer kept me from running anywhere but the treadmill at the air conditioned gym for three weeks. I never felt acclimatized to the severe humidity, and even my little 30 minute runs became a struggle. In September I ran a 5k race and missed my 30-minute goal by 30 seconds. I got discouraged. But running gave me more energy and I knew if I stopped, I'd lose the gains that I'd worked so hard to achieve. So I kept running.

Soon I began to notice strange urges-- when I was at home in the evening, I'd think about going for a run. If I hadn't run the day before, I'd be thinking about running throughout the day. It's wasn't a guilt... it was a craving. I ran in the rain. I ran in the snow. I ran in the cold. And at some point along the way I realized that I enjoyed running.

I'll never win any races. I'm not breaking any land-speed barriers. But I've recently committed to running a half marathon in May. I'll be happy if I run it in less than 2.5 hours. My closet is filled with running shoes in various states of destruction and I use words like Fartlek and Body Glide without giggling.

I guess I'm a runner.

Meme-y Goodness

Steph from Ice Cream and Puppy Dog Tales has tagged me with the latest Meme to be traveling at warp speed through cyberspace. The theme of the meme (hey... that rhymed!) is to come up with five things about myself that are somewhat interesting. A challenge for me, however, as I'm still trying to keep this blog somewhat anonymous.

So here is my attempt at coming up with five things about me that are relatively interesting without being too revealing.

1. I am fluent in French and English, and at one time I spoke pretty passable Spanish.

2. I have a secret fetish for celebrity gossip magazines. I don't buy them, but I manage to read them in hiding at the office, at the gym or at Starbucks.

3. My favorite colour is orange. My husband finds that odd.

4. I used to be a member of the Church of Jesus Christ of Latter Day Saints (the Mormons). I left the church when I was 21 years old.

5. I am a huge fan of Buffy the Vampire Slayer. I still mourn its cancellation.

I don't usually like to tag, but this time I'm making an exception:

Vitamin K, just cause I miss her. And I'm curious if there are 5 things I don't know about her!

Nikki, cause I just found her new blog and I'm excited that she's writing again.

A Girl, from FIFE-me. Just because I like her stuff and I think that more people should be reading her blog.

And that's all.

Who Knew?

The longer it's been since medical school, the more I realize how little I actually learned in medical school. Particularly in terms of practical knowledge.

Take pregnancy, for example. Getting pregnant seems to be something that should be pretty straightforward. Insert Tab A into Slot B, so to speak. But since Mr. Couz and I started contemplating kidlets of our own (aside from our fur-kids, I mean), I've learned a lot of things about procreation that make me wonder what the hell I was DOING for four years.

Things that were complete news to me:

• It takes an AVERAGE of 8 months for a woman in her early 30's to get pregnant (in the absence of any fertility issues)
• If your (non-hormonal) cycles are longer than 36 days, they are likely to be anovulatory
  
• Pretty much all lubricants are spermicidal
  
• Saliva is also spermicidal
• Having sex daily will decrease your chances of conceiving when compared to doing it every second day or so-- apparently, doing it daily results in lesser quality sperm
  

I'm sure there are more, but these are the ones that come to mind immediately. But the most important message here is this-- when a type A personality and her husband decide to pull the goalie and let the fates decide from there, it is only a matter of days before she succumbs to the innate drive to read many books on the subject, starts charting her basal body temperature on fertility websites and obsessively analyzing charts and coverlines and prematurely puts down a deposit on a Bugaboo Frog.

Sigh. I can't be laid-back about anything anymore.

What Bugs Me Today

As some of you may remember from previous posts, I still haven't really decided on my stance when it comes to pharm reps. Right now I'm leaning in the direction of banning them from my future practice entirely, in the spirit of No Free Lunch. As an emerg doc I won't really be a target of drug reps anyway... although if I continue to keep a foot in family practice by moonlighting in a walk-in clinic or student health centre (which is my intention right now), it will likely become an issue.

But what annoys the crap out of me is the doctors that act all sanctimonious about the fact that they don't meet with drug reps but have no problem accepting drug rep money to fund a golf tournament, a hockey tournament, a CME dinner or other doctor-centered activity. They don't see their stance as hypocritical as they don't see it as 'direct' influence.

Grr.

Mmmm... Books.

I love books. I've always loved books. I admit it. My obsession started early, with Archie comics and Peanuts paperbacks. I was the kid who would be up at night with a flashlight under the covers trying to read one more page before being discovered by my mom. I eagerly anticipated the days my mom would bring us to the library, my sisters and I leaving with armfuls of hardcover books with crinkly covers. There was no feeling like cracking the spine of a brand new book. I've always loved bookstores-- from the tiniest hole-in-the-wall to the enormous Chapters/Indigo/Borders type-places, I can browse for hours.

I don't have much time to read for pleasure anymore, but I still get the same excitement out of books. Even the kind I 'have' to read. This has not always been a good thing. I don't know what on earth possessed me to buy our medical schools recommended pharmacology textbook-- I think I used it once in second year to look up some pharmacodynamics for a PBL session. I also have a nearly untouched Robbins Pathological Basis of Disease... I know that the American medical schools tend to regard this as a bible, but I managed to get through medicine with much more user-friendly texts. Other buys that made more sense at the time were a very good (and very large) textbook on rheumatology (on which my experience beyond the classroom has been non-existant) and a lovely (but somewhat heavy) textbook on infectious disease. That one I should probably crack open again-- I could use a refresher on bugs and drugs. But even now, I find browsing through a medical bookstore one of my favorite ways to spend a free hour.

These days, I'm a lot more careful about buying books. I don't buy books randomly at the start of every new rotation. In fact, since buying a subscription to up-to-date and installing the Lexi series on my PDA, I don't really use textbooks much at all anymore. And the ones I do buy I make sure will be a good investment-- a book that I'm likely to use and refer back to in the future. So most of those are relating to emergency medicine in some way.

Sometimes this works better in theory than in practice. My last major book purchase was one of the bibles of emergency medicine, Tintinalli. (When you're this well known in the world of emergency medicine, you're referred to by name) It was an exciting purchase to make... this text, together with Rosen, form the basis of resident preparation for the emergency medicine board exams. I eagerly dug in-- with each new rotation in my internship year, I'd read the corresponding section of Tintinalli. Great idea, right? Problem was, this textbook is about 5 inches thick. Not terribly portable, particularly for someone who does her best studying over non-fat vanilla lattes at Starbucks. On top of that, the weight of the book causes self-imposed time limits on studying. More than 45 minutes at a time causes painful ridges to form across the tops of my thighs where the book rests when I read. I think that Rosen had the right idea when they split their bible into three volumes.

So it's been a while since I've purchased any new medical books. Which is why I've been anxiously stalking the mailman for my package from Amazon. New medical books... yay!

First I got a family medicine text. It was less than $100 (a bargain for medical textbooks) and it much more complete than the Mosby text I'm using now. I wanted something beyond the review materials being passed around the internet when I'm studying for the CCFP licensing exam which is coming up in a little more than three months. This exam is freaking me out-- coming into family medicine from emerg and therefore knowing nothing about family medicine-oriented subjects like psychiatry, screening for disease and guidelines for management of primary health care issues, I still feel like I'm at a bit of a disadvantage. So over the next few months, I have some catching up to do. A friend brought this text to one of our academic days not too long ago and I really liked it-- complete, readable and relatively cheap. Add that to the shiny cover and pretty pictures and it's pretty much the perfect textbook. I was sold.

As long as I was ordering a book for exam prep, I decided to throw in another text that I've been eyeing for the better part of a year. The ICU book has been recommended by everyone I know who has read it. Seeing as how I'll be spending the month of June in the ICU here, another month of ICU next year during my emerg year, and will be using many of the procedures and protocols described in the emergency room. I had been waiting for the new edition to come out, so it's the perfect opportunity.

And speaking of perfect opportunities, Amazon.ca was offering The ICU Book in combination with another book I had my eye on, the Manual of Emergency Airway Management. This is another topic I'm a little insecure about, in spite of the month of anaesthesia that was intended to teach me these skills. All I've done in an emergency situation is fairly straightforward endotracheal intubation. The fancier stuff I've seen done in controlled situations, but I'd like to have more in my arsenal when some apneic 300lb guy with a Mallampati IV oropharynx rolls in the door. I'm hoping I get a lot more out of my next month of anaesthesia than I did in my first. I am perfectly aware that the techniques that will save my ass in a tight situation aren't the kind that can be taught in books, but I'm hoping it will be a good start.

Mmmm. Books. Love em. I can't wait. Now if only I could find the time to READ them, I'd be laughing.

Just When You Thought It Was Safe to Go Back in the Water...

Okay, surgery isn't Jaws II. But what I mean to say is that it's often shocking how complacent you can get around things when everything goes well for a while.

It's been a long time since I've been away from the academic centre... or to borrow a phrase from The Flea, TBFTHITW.* Things in the community are... well, nice. Patients come into hospital with usual things, like urosepsis and COPD exacerbations. Some are palliative, and pass away quietly with adequate pain control. Surgery happens, people recuperate and rehab. Births happen, very rarely by c-section, and require nothing more in the way of intervention than a few absorbable sutures for mom and some blow-by oxygen for the baby. It's easy to fall into the complacency trap.

Last weekend I was on call for my preceptor's call group. Now that his call group no longer accepts the care of orphaned patients, rounding on the group's patients in the hospital rarely takes longer than 3-4 hours. Mercifully short, and I can often salvage at least enough of the weekend to go for a long run while there is still daylight left.

On Saturday, one patient on our list stood out like a sore thumb among the usual band of CVAs, ACSs and 'gastro+dehyrations'-- a kid in the ICU. Hmm. Don't see that everyday, particularly not in our sleepy community hospital.

So the story is this-- healthy kid sustains a fracture. Not a serious fracture, but it is slightly displaced and may not heal correctly without intervention. Enter surgeon who arranged for an ORIF of said relatively minor fracture (Open Reduction and Internal Fixation-- basically, we cut you open and put your bones back together, then make sure they stay that way).

It should be routine. Instead, as the kid was emerging from anaesthetic he bit down on the tube. The details are sketchy-- I wasn't there, just read the notes from anaesthesia in the chart. The patient was intubated with an LMA (as an aside, does anyone else think that those things resemble female genitalia?) and when he bit down, it obstructed the flow of oxygen through the tube. When someone is in this state-- emergence-- you can yell in their ear to stop biting down all you want and it won't make a difference. They have little to no control over their actions, but are no longer under the effects of the muscle paralytic. So as this guy's oxygen went down-- and it went WAY down, to about 50% O2 sat as evidenced by the OR record-- he continued to bite down reflexively. And then, likely secondary to hypoxia... his heart stopped.

Holy crap. At this point I was sitting at the ICU nursing station, reading the kids chart like a bestselling novel. A full 10 seconds of asystole. Basically, the kid was dead. Compressions were started, and eventually the anesthesiologist got another dose of sux into him which re-paralyzed him. The situation improved from here.

The result of all this was non-cardiogenic pulmonary edema-- basically, a heckuvalotta fluid in the lungs. Not so good for the breathing. And more fluid third-spacing... going to places it shouldn't. The poor kid looked like the Stay-Puft marshmellow man on a CPAP. After 18 hours or so on CPAP, the intensivist managed to wean him down to O2 by nasal prongs, but attempts to wean him beyond that resulting in rapid desats.

The poor kid and his parents were stunned. Thankfully, the story had a happy ending... he hung out in the ICU for a couple of days until he was able to be successfully weaned from supplemental O2 and went home, none the worse for wear.

Still... scary story. Serves me right for starting to think of surgery on healthy people as 'routine'.


* The Best Fucking Teaching Hospital In The World, a phrase intended to illustrate the view of the staff/clinicians/trainees at said hospital that everything done there must be the right way to do things, because we're TBFTHITW.

Knock, knock... who's there?

Who is staffing our emergency rooms these days? Around these parts, it's a hot topic. When I first moved to this town to start my residency training in emergency medicine, one of the teaching hospitals affiliated with the university had undergone a pretty dramatic upheaval. For some reason not fully understood, the hospital emergency room was being staffed by Med-Emerg, a medical staffing agency. Basically, they take over responsibility for staffing the emergency room. This was significant as it required pulling all residents out of this hospital, as Med-Emerg staff were not affiliated with the university and therefore not able to teach residents. Word around the Valium fountain in the Emergency Department was that they staffed ED's with fresh grads, most of whom didn't have any emerg training. Family doctors who got paid handsomely to drop in and staff a shift with no commitment to the hospital or the community. I'm not entirely sure why docs affiliated with this agency are instantly deemed inferior, but it definitely had an impact on the residency training in our academic centre. After the Med-Emerg one year contract with the hospital expired, the hospital was again staffed by university-affiliated staff docs. And now, residents are back in the ED there.

The Med-Emerg solution is costly, but probably better than the other alternative to EDs facing severe staffing shortages. Another ED in the region facing closure due to staff shortages managed to stay open by recruiting a CCFP-EM resident (a resident who has finished training in family medicine and is currently doing an additional year of training to specialize in emergency medicine) to cover its weekend shifts. This was widely reported in the news at the time, trumpeted as a 'partnership' between medical academia and the government to meed the regions needs.

Crazy. This wasn't a success! This was a clear failure of the system. The ED had to reach into the pool of medical trainees for staff-- while I'm impressed that the resident in question had the cojones to work without backup in a busy emergency department just two months after finishing her family medicine residency, I wouldn't have felt comfortable in that situation. Why would I be doing a third year in emergency medicine if I could just walk into an ED with nothing but my family medicine certification and an 'interest' in emergency medicine and work without concern?

This is likely to happen more and more often in a system where supply is clearly falling short of meeting demand. In Canada, there are 27 spots in FRCP Emergency Medicine each year. Twenty-seven. For ALL of CANADA. The year I matched there were about 75 applicants for these positions. Granted, these are the spots intended for academic positions in emergency medicine, but it still seems like a ridiculously small number. In the stream that I'm in, the CCFP-EM program, there are about 6 spots for each academic centre. In spite of that, there is still considerable competition for these training spots. So my point is that the lack of qualified staff to man emergency departments is certainly not from lack of interest on behalf of residents.

Now things seem to be going one step further. Out east, one politician believes that the solution lies in staffing emergency departments with nurse practitioners and paramedics. I'm not sure how, in the words of Kevin, M.D., NP + paramedic = ER doc. Paramedics are not trained in any way to diagnose disease. The paramedics scope of practice pretty much ends at assessment. Treatment is only given insofar as it fits into one of numerous protocols set forth by the BLS Manual. Advanced Care Paramedics do have an extended scope of practice, but again are not trained to diagnose disease. I do not understand the role that they are intended to play in replacing physicians at the helm of the emergency department.

I'm not putting doctors on a pedestal here. In fact, I've never really understood the difference between a primary care nurse practitioner and a primary care physician. Both may assess and examine the patient, both may order diagnostic tests, both may diagnose disease, both may prescribe and/or administer treatment. So if nurses can do all this, why have primary care physicians at all? What can they do that NP's can't?

My exposure to NP's has been restricted to academic centres. I've worked with them in the dialysis unit, in the NICU and in the PICU. Their role in those places seems to be similar to that of the Physician Assistant in the U.S. (we don't have PA's in Canada)-- but they work as members of a team, not independently from the physician. So you can understand my confusion when it comes to the role of NP's practicing independently in the community. I know this happens in remote places, but I've never had first-hand experience.

When I think about it, though, it's kind of frustrating for the primary care physician. NP's are trained in just 12 months (if they hold a university B.Sc.N) or 24 months (if they held a college nursing RN) according to this journal article. It's no wonder doctors are worried. Compare that to the university degree (4 years), medical school (4 years) and residency (2 years minimum) completed by a primary care physician and it's easy to understand why there might be resistance to declaring the two equivalent. If a NP can do a family doctor's job, why would a wanna-be family doctor bother doing medical school at all? Not when the same end may be accomplished with half the years of training and a fraction of the debt load.

Seems like a shortsighted solution to the physician staffing problem.

Why the Nurses Love Me

Yesterday morning I was rounding on a patient who is on the surgical floor, awaiting an ERCP. I was discussing some issues with the charge nurse when a middle-aged man in scrubs approached the desk.

"Who is Sue?" He boomed, clearly expecting immediate attention.

The charge nurse turned to him. "We've both been working here over 20 years and you still don't know my name?"

The man in scrubs shrugged, clearly unmoved. "Nurses are generic."

And with that, he grabbed a chart, spun on one heel and left. Nurses rolled their eyes in the general direction of his back.

"Who the hell was that?" I had to know, if for no other reason than to avoid him carefully in the future.

"Dr. Pompous,"* she replied. "He's the oral surgeon. He doesn't come in much, which is probably why you haven't met him yet."

Thank God. So Sue and I go back to our discussion of how to best reverse my patient's anticoagulation until Dr. Pompous blows back into the nursing station.

"I want her NPO today before I touch her." He announced. I had been in mid-sentence, a fact which clearly did not faze Dr. Pompous. He stepped in front of me to address Sue as though I wasn't even there.

I saw red. This kind of bullsh*t might be shrugged off my the nurses, but I didn't have to play the academic hierarchy game anymore.

"Oh, I'm sorry," I said loudly, "I thought I was speaking here."

Dr. Pompous stopped in mid-sentence. He turned to face me with an eyebrow raised, clearly trying to size me up.

"I'm sorry," he said, clearly not sorry in the least. "I'm Dr. Pompous. And you are?"

"Dr. Couz," I replied, putting the emphasis on the title. I didn't explain further.

That changed the game a bit. He sputtered a bit, then backed down and let me continue my conversation with the charge nurse.

If I were a little gutsier, I would have replied: "I'll try to remember your name, but surgeons are generic."

Freaking surgeons.

* Names have been changed to protect the innocent... and the pompous.

The Scutmonkey Rules

Okay, I rarely do this-- post passages directly from another blogger. But rarely does another blog actually make me laugh out loud. Which isn't so great if I'm working on my laptop, say, in the middle of Starbucks. People think I'm crazy. But this recent exchange, ever-so-wonderfully captured by Michelle over at The Underwear Drawer, was worth risking a Form 1.

(That 'Form 1' comment was a medical joke. And jokes like that are why I will never be cool.)

So for context, Michelle is an anesthesiology resident in NYC. And this recent OR exchange illustrates what is wrong with the traditional medical mentality:

So of course Joe and I had to work this last week, but thankfully the OR schedule has been somewhat light, with the exception of the orthopedic rooms, because those orthopods just don't know when to stop. Yes, they love doing surgery, and I respect that, but at some point, don't you think that stopping the smell the roses or having outside pursuits is a sign of a fully realized life? Or am I just a lazy turd?

Apparently the latter, according to the neurosurgeons. I was in a neuro case just the other day when the following conversation transpired between the surgical team and myself. They were discussing interdepartmental rivalries between our institution and [Upper East Side Affiliate Hospital]. You know, the surgeons down there talking smack about the surgeons up here and vice versa. The attending surgeons then posed this question.


NEUROSURG ATTENDING
How about Anesthesia? Did the anesthesiologists down there have some sort of big rivalry with the group up here?

SCRUB NURSE
[Who has worked at both hospitals]
No, the anesthesiologists were pretty laid-back.

NEUROSURG RESIDENT
Anesthesia doesn't have rivalries because anesthesiologists have no ego.

MICHELLE
I'm trying to figure out if you said that as a compliment or an insult.

NEUROSURG RESIDENT
(Bitterly)
All Anesthesia wants to do is go home! You know they leave at 4pm some days? 4pm!

MICHELLE
Um, it's 7pm now, and I'm right here.

NEUROSURG RESIDENT
(Starting to froth)
I get into work at 4am and leave at 10pm! They get six extra hours in their day! Six hours! That's a whole life!

MICHELLE
That's exactly right. That is a whole life. My whole life outside of the hospital.

NEUROSURG ATTENDING
If all you want to do is go home, why be a doctor at all?

MICHELLE
I don't think that wanting regular hours means that you shouldn't be a doctor. I think that having regular hours enables me to be a doctor and something else too.

MICHELLE'S INNER MONOLOGUE
Like a human being.

NEUROSURG ATTENDING
Ignore us, we're just jealous.

NEUROSURG RESIDENT
(Mumbling angrily to self)


It's this strange attitude in medicine, this macho thing, that in order to be the best, most committed, most self-sacrificing, most punk rock doctor, you have to basically sell your soul to the hospital. LOOK AT ME IN AWE AND WONDER, FOR I HAVE NO OTHER LIFE. I just don't really get that attitude. I mean, I'm glad there are people like that out there, I suppose. I mean, when it comes down to it, most of us will do what we need to do to take care of a patient in trouble, regardless of what time of day it is. But on the other hand, doesn't it make you a better doctor to, I don't know, take a break once in a while? Or think of it another way--do you want to be operated on at 8pm, the fourth elective CABG of the day, after your surgeon has been awake for the past 30 hours?

("No" and "Hells, no" are both acceptable answers.)

Thank God I'm not the only one that thinks that medicine and having a life are not incompatible life goals.

If you want to read more of Michelle's wicked and warped sense of humour, check out her blog at The Underwear Drawer. I only recently discovered that she is also the force behind Scutmonkey, who was the originator of the Twelve Types of Med Students that circulated around my med school class way back when. Check her out. Seriously.